Provider Demographics
NPI:1922064807
Name:JOHNSON, STEPHEN MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MORRIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 N GANTENBEIN AVE
Mailing Address - Street 2:DEPT OF PEDIATRICS, EMANUEL CHILDREN'S HOSPITAL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-413-2566
Practice Address - Street 1:EMANUEL CHILDREN'S HOSPITAL, DEPT OF PEDITATRICS
Practice Address - Street 2:2801 N. GANTENBEIN AVE.
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-413-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD236662080P0208X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286736Medicaid
OR115898Medicare ID - Type Unspecified
OR286736Medicaid